Here, we report a rare presentation of symptomatic multiple myeloma with normal serum protein electrophoresis (SPEP) but elevated serum-free light chains during serum immunofixation. The treatment plan consists of oncology referral for chemotherapy and bone marrow stem cell transplant consideration. Diagnostic workup will include differential complete blood count (CBC), beta-2 microglobulin tests, immunoglobulin studies, skeletal survey, and bone marrow biopsy. Some patients may only present with abnormal laboratory tests like anemia, hypercalcemia, or increased protein levels. Unexplained bone pain (most commonly in back and ribs), pathologic fractures, fatigue, and weight loss are common initial symptoms at presentation. Patients are diagnosed at a median age of 66-77 years with 37% of those with age less than 65. These clonal plasma cells synthesize and secrete unusually large quantities of abnormal immunoglobulin that can result in end-organ dysfunction. (n.d.).Multiple myeloma is a neoplasm described as an abnormal growth of plasma cells that outnumbers the other normal hematopoietic cells inside the bone marrow. Understanding MGUS and smoldering multiple myeloma.An overview of light chain multiple myeloma: Clinical characteristics and rarities, management strategies, and disease monitoring. (2020). Multiple myeloma: Available therapies and causes of drug resistance. Multiple myeloma: Diagnosis and treatment. Association of immune marker changes with progression of monoclonal gammopathy of undetermined significance to multiple myeloma. (2020). High-risk smoldering myeloma versus early detection of multiple myeloma: Current models, goals of therapy, and clinical implications. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. We link primary sources - including studies, scientific references, and statistics - within each article and also list them in the resources section at the bottom of our articles. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. If the tests show M protein in the blood, a doctor may recommend further tests. A doctor may perform this test to detect the amount of M proteins in a person’s bloodstream. Serum heavy/light chain assay test: The test measures both light and heavy chains bound together.If one is higher than the other, however, it can be a sign of myeloma. Serum free light chain assay test: Normally, the light chains kappa and lambda have about equal numbers of each in the blood.Urine tests: These tests look at how much M protein has filtered through the kidneys.Blood tests: One example is a quantitative immunoglobin test, which measures the amount of each heavy chain present in the blood.A doctor will follow this up with a test called immunofixation, which can identify the abnormal protein. This is the definitive test for an M spike, which gets its name for the characteristic spike that the M protein creates on the test result. Serum and urine protein electrophoresis: This is a blood test that measures all proteins in the blood and looks for any protein present in abnormally high concentrations.Some tests that a doctor may use to check for M protein in the blood include: Doctors often find high M protein counts incidentally during routine blood tests. This causes light chain myeloma, which affects 15% of people with multiple myeloma.īecause multiple myeloma does not cause any symptoms until it progresses, it can be hard to diagnose early. Occasionally, M proteins only make light chains. Occasionally, traditional methods may not detect IgA myeloma, so it may not show up as an M spike. IgG and IgA are the most common types of myeloma. For example, people with IgM myeloma may have a rare type of cancer called Waldenstrom macroglobulinemia. This is important because the types of M proteins can tell doctors what kind of myeloma a person has, and this can inform treatment decisions. So, if a person has IgA heavy chains and kappa light chains, all of their proteins will be IgA kappa. M proteins always produce the same types of cells. In myeloma, the M proteins can be made up of one type of heavy chain and one type of light chain. Typically, antibodies are made up of two heavy and two light chains. These are pieces of the protein, and they can be heavy chains or light chains.
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